1007 R.R. 620 S. Suite 201 | Austin TX
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      1007 R.R. 620 S Suite 201

      Austin, TX 78734

      Welcome to our office and to the Lakeway Orthodontics Family!

      In order to make your first appointment as smooth as can be, Please print and fill out the forms here and bring them to your appointment.  You can also scan and email them to us at info@lakewayortho.com  See you soon!

      Questions about anything on the forms?  Call us and we can help 512-263-2993

      YOUR RIGHTS:
      You may request, in writing, a copy of your health information we may charge a reasonable fee for this service.
      Upon request, a more detailed and lengthy explanation of our polocies is available.

      Questions and Complaints: If you have any issues concerning the privacy of your health information, you may direcy your complaints to the person listed below. You may also submit a written complaint to the US Dept. of Health and Human Services.

      Contact Officer: Dr. Brian Bolerjack
      512-263-2993
      email: info@lakewayortho.com
      1007 RR 620 S, Suite 201
      Austin Texas 78734